Vancomycin-associated nephrotoxicity: A meta-analysis of administration by continuous versus intermittent infusion

Timothy Hanrahan; Tony Whitehouse; Jeffrey Lipman; Jason A Roberts

doi:10.1016/j.ijantimicag.2015.04.013

Vancomycin-associated nephrotoxicity: A meta-analysis of administration by continuous versus intermittent infusion

Int J Antimicrob Agents. 2015 Sep;46(3):249-53. doi: 10.1016/j.ijantimicag.2015.04.013. Epub 2015 Jun 7.

Authors

Timothy Hanrahan¹, Tony Whitehouse², Jeffrey Lipman¹, Jason A Roberts³

Affiliations

¹ Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
² Department of Anaesthesia and Critical Care, University Hospital Birmingham, Birmingham, UK.
³ Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia; Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: j.roberts2@uq.edu.au.

PMID: 26141230
DOI: 10.1016/j.ijantimicag.2015.04.013

Abstract

Vancomycin is a glycopeptide antibiotic widely used in the management of meticillin-resistant Staphylococcus aureus (MRSA). Guidelines currently recommend vancomycin be administered by intermittent infusion, despite recent research suggesting that continuous infusion (CI) may be associated with lower rates of vancomycin-associated nephrotoxicity. In 2012, Cataldo et al. presented a meta-analysis supporting the use of CI. Here we present an updated meta-analysis, inclusive of a recently published large-scale retrospective study. PubMed, EMBASE and Cochrane Reviews databases were searched using the keywords 'vancomycin' and 'continuous' or 'intermittent' or 'infusion' or 'discontinuous' or 'administration'. Seven studies were included in the final analysis. Using a random-effects model, a non-significant trend of reduced nephrotoxicity in those who received vancomycin by CI (risk ratio=0.799, 95% confidence interval 0.523-1.220; P=0.299) was identified. A large, randomised controlled trial is necessary to confirm these results.

Keywords: Acute kidney injury; Glycopeptide; Infection; Intensive care unit; Sepsis; Vancomycin.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Acute Kidney Injury / chemically induced*
Acute Kidney Injury / epidemiology*
Anti-Bacterial Agents / administration & dosage*
Anti-Bacterial Agents / adverse effects*
Humans
Infusions, Intravenous / methods
Methicillin-Resistant Staphylococcus aureus / drug effects
Retrospective Studies
Staphylococcal Infections / drug therapy*
Staphylococcal Infections / microbiology
Vancomycin / administration & dosage*
Vancomycin / adverse effects*

Substances

Anti-Bacterial Agents
Vancomycin